198603149-12-12-2023-28-AS-LHIS-CYMUB3-20231218142541

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603149
Report Date: 12/12/2023
Date Signed: 12/12/2023 03:42:14 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/19/2023 and conducted by Evaluator Jewel Baptiste

COMPLAINT CONTROL NUMBER: 28-AS-20230119140254

FACILITY NAME:	WASHINGTON HOME		FACILITY NUMBER:	198603149
ADMINISTRATOR:	DIXON, PAMELA		FACILITY TYPE:	735
ADDRESS:	475 W WASHINGTON BLVD		TELEPHONE:	(213) 361-2792
CITY:	PASADENA	STATE: CA	ZIP CODE:	91103
CAPACITY:	4	CENSUS: 4	DATE:	12/12/2023
		UNANNOUNCED	TIME BEGAN:	09:48 AM
MET WITH:	Administrator Melinda Pippens		TIME COMPLETED:	03:56 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff caused injuries to a client while in care
Staff hits a client while in care
Staff interfered with a client's medical appointment

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 12/12/2023 at 9:48 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted a subsequent complaint visit to investigate the above listed allegations. The purpose of the visit was discussed with Administrator Melinda Pippens.

During the initial visit on 1/20/2023, LPA Alma Gonzalez obtained a copy of Staff Roster and a list of facility staff's contact information. LPA conducted a tour of the buildings and grounds and observed clients in care, LPA did not observe any signs of neglect, abuse or other immediate health and safety threats. LPA interviewed Administrator Melinda Pippens. Additionally, LPA reviewed Client files for C1-4 and collected copies of various documents from client files.

Report Continued on 9099c

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/12/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 2

Control Number 28-AS-20230119140254

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: WASHINGTON HOME	FACILITY NUMBER: 198603149
	VISIT DATE: 12/12/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

During today’s visit LPA Baptiste obtained the staff roster, client roster, Frank D. Lanterman outcome of their investigation, C1’s face sheet, and LPA interviewed the Administrator Melinda Pippens and a total of three (3) staff who shall be referred to as S1, through S3. LPA attempted to interview C1 through C4 but due to their medical diagnosis LPA could not use their interviews. LPA interviewed C1’s one on one care provider from Maximum, C1’s current Service coordinator, and C1’s former Service coordinator who shall be referred to as Witness #1(W1) through Witness #3 (W3). LPA attempted to interview C1’s responsible party and left a voice mail.

The investigation reveals the following: Regarding “Staff caused injuries to a client while in care”. It is alleged that staff caused injuries to C1. The Administrator denied the allegation stating staff has never caused any of their client’s injuries. 3 out of 3 staff denied the allegation stating they have never caused the client’s injuries or witnessed it happening at the facility. 2 out of 3 witnesses stated they have investigated the allegation and found it Unsubstantiated. 1 out of 3 witnesses stated, since they have taken care of the client, they have not witnessed the facility staff injuring the clients. LPA reviewed Frank D. Lanterman regional center findings and observed the allegation was unsubstantiated. LPA reviewed C1’s IPP and observed the client has aggressive behaviors.

The investigation reveals the following: Regarding “Staff hits a client while in care”. It is alleged the staff hit C1. The Administrator denied the allegation stating staff has never hit any of the clients. 3 out of 3 staff denied the allegation stating they have never hit any of the clients or witness other staff hitting the clients. 2 out of 3 witnesses stated they have investigated the allegation and found it Unsubstantiated. 1 out of 3 witnesses stated, since they have taken care of the client, they have not witnessed the facility staff hit the clients. LPA reviewed Frank D. Lanterman regional center findings and observed the allegation was unsubstantiated.

The investigation reveals the following: Regarding “Staff interfered with a client's medical appointment”. It is alleged that staff did not take C1 to the hospital to hide injuries. The Administrator denied the allegation stating staff took C1 to urgent care and has never stopped a client’s appointment. 3 out of 3 staff denied the allegation stating staff have taken the clients to urgent care when needed. 2 out of 3 witnesses stated they always take clients to their medical appointments or the emergency room when needed. 1 out of 3 witnesses stated they are not involved with the client’s appointments.

Based on LPA's interviews, investigation revealed: Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted with Raiko Vides and a copy of this record provided.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/12/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2